Alcohol Withdrawal Syndrome in Neurocritical Care Unit: Assessment and Treatment Challenges

Farrokh, Salia; Roels, Christina; Owusu, Kent A.; Nelson, Sarah E.; Cook, Aaron M.

doi:10.1007/s12028-020-01061-8

Cited by 21 publications

(31 citation statements)

References 90 publications

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“…The symptoms include visual hallucinations, illusions, extreme fear, psychomotor agitation, irritability and insomnia – consistent with the present case. 17 , 18 During the alcohol withdrawal phase, antipsychotics are usually used to control these aforementioned psychotic symptoms. 19 This dopamine blockade is associated with EPS, but reduces DRD2 occupancies, and puts the addicted individuals at a higher risk of EPS, as evident in the present case.…”

Section: Discussionmentioning

confidence: 99%

Extrapyramidal Side Effects in a Patient with Alcohol Withdrawal Symptoms: A Reflection of Quality of the Mental Health Care System

Kaggwa¹,

Nkola²,

Najjuka³

et al. 2021

RMHP

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Background The burden of substance use disorders is increasing in most countries in sub-Saharan Africa. Individuals with substance use disorders (eg, alcohol use disorder) are at high risk of manifesting extrapyramidal side effects or extrapyramidal symptoms (EPS) during treatment of alcohol-induced mental illness symptoms especially psychosis. EPS management poses a challenge since some of the drugs used for treating EPS have addictive properties. The knowledge about EPS diagnosis and treatment is not well distributed across the health system, with health workers at lower health facilities having least awareness. The present case gives details of a patient who developed EPS during the management of alcohol withdrawal symptoms. Case Details Following cessation of alcohol use, a 54-year-old man with alcohol use disorder presented with a one-week history of visual, auditory and tactile hallucinations, illusions, insomnia, extreme fear and irritability. He was managed with several daily doses of intramuscular chlorpromazine 100 mg, whenever he woke up aggressive from sedation from a peripheral health facility. Four days after his admission, he became mute, stiff, immobile, triple-flexed, tremulous and was drooling saliva. He was referred to a secondary facility for further management while on antipsychotic medication. Finally, he was referred to a tertiary facility, managed with tablets of benzhexol 5 mg twice daily and intravenous diazepam 20 mg per day. Daily follow-up was done using the extrapyramidal symptom rating scale (ESRS) for EPS. EPS symptoms resolved ten days after initiation of treatment. Conclusion EPS among individuals with addictive disorders poses a challenge in its management, especially in countries where the mental health care system is not well developed at lower-level health facilities. The mental health system has to prepare sustainable interventions to properly manage EPS among the growing population of individuals with addictive disorders through strengthening the mental health policy by training and equipping all health providers with knowledge and skills in managing EPS, increasing finances allocated for mental health and controlling the production and use of addictive substances.

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Section: Discussionmentioning

confidence: 99%

Extrapyramidal Side Effects in a Patient with Alcohol Withdrawal Symptoms: A Reflection of Quality of the Mental Health Care System

Kaggwa¹,

Nkola²,

Najjuka³

et al. 2021

RMHP

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“…Adjunctive therapy with valproate, carbamazepine or levetiracetam reduces the risk of withdrawal-related epileptic seizures. Valproate has been shown to reduce the duration of pharmacological treatment and the length of hospital stay [16]. However, hepatotoxic effects have to be considered especially in patients with alcohol-induced hepatopathy.…”

Section: Alcohol Withdrawal Deliriummentioning

confidence: 99%

SOP: treatment of delirium

Kukolja

Kuhn

2021

Neurol. Res. Pract.

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Introduction Delirium is a frequent complication in hospitalised patients, often leading to difficulties in patient management and is associated with increased morbidity and mortality. Most patients in intensive care units develop delirium, however, it is also frequently observed in non-intensive care unit settings. Risk factors are, among others, older age, brain pathology, severe trauma, orthopaedic or heart surgery, metabolic or electrolyte dysregulations, infections and polypharmacy. The most important measures to prevent and treat delirium are recognition and removal of risk factors and causes. Although delirium is a very common and serious complication, evidence for pharmacological treatment is poor, and guidelines remain controversial. Accordingly, non-pharmacological treatments have gained increasing attention and should be applied. Based on current literature, guidelines and personal recommendations, we developed a standard operating procedure (SOP) encompassing non-pharmacological and pharmacological treatment of delirium. Comments In order to prevent delirium, risk factors should be identified and taken into account when planning the hospital stay and treatment. Prevention should include multimodal non-pharmacological interventions. The treatment of delirium should encompass the elimination of potential causes and non-pharmacological interventions. Pharmacological treatment should be used in a time-limited manner and in the lowest possible dose for the management of highly stressful symptoms or high-risk behaviour. Conclusion The SOP provides a pragmatic algorithm for the non-pharmacological and pharmacological treatment of delirium.

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“…The intended audience of this narrative review is primarily clinicians working in specialist addiction treatment settings, with a focus on planned medically assisted alcohol withdrawal (MAW) as a part of a longer treatment journey. Although consideration will be given to the management of unplanned withdrawal in hospital settings, severe complications of the alcohol withdrawal syndrome (AWS) such as seizures and delirium tremens are medical emergencies and detailed reviews of treatment regimens are available elsewhere [1][2][3][4][5][6][7][8]. Both authors have been part of the Public Health England expert group to develop the United Kingdom's (UK) first national treatment guidelines for alcohol use disorders, which in turn was supported by evidence from the UK National Institute for Health and Care Excellence (NICE) guidance [9,10].…”

Section: Introductionmentioning

confidence: 99%

Clinical management of the alcohol withdrawal syndrome

Day

Daly

2021

Addiction

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Up to half of individuals with a history of long-term, heavy alcohol consumption will experience the alcohol withdrawal syndrome (AWS) when consumption is significantly decreased or stopped. In its most severe form, AWS can be life-threatening. Medically assisted withdrawal (MAW) often forms the first part of a treatment pathway. This clinical review discusses key elements of the clinical management of MAW, necessary adjustments for pregnancy and older adults, likely outcome of an episode of MAW, factors that might prevent completion of the MAW process and ways of overcoming barriers to ongoing treatment of alcohol use disorder. The review also discusses the use of benzodiazepines in MAW. Although there is clear evidence for their use, benzodiazepines have been associated with abuse liability, blunting of cognition, interactions with depressant drugs, craving, delirium, dementia and disrupted sleep patterns. Because glutamatergic activation and glutamate receptor upregulation contribute to alcohol withdrawal, anti-glutamatergic strategies for MAW and other potential treatment innovations are also considered.

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Alcohol Withdrawal Syndrome in Neurocritical Care Unit: Assessment and Treatment Challenges

Cited by 21 publications

References 90 publications

Extrapyramidal Side Effects in a Patient with Alcohol Withdrawal Symptoms: A Reflection of Quality of the Mental Health Care System

Extrapyramidal Side Effects in a Patient with Alcohol Withdrawal Symptoms: A Reflection of Quality of the Mental Health Care System

SOP: treatment of delirium

Clinical management of the alcohol withdrawal syndrome

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